Provider Demographics
NPI:1942227681
Name:CHAND, NILIMA PRASAD (MD)
Entity type:Individual
Prefix:
First Name:NILIMA
Middle Name:PRASAD
Last Name:CHAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0107
Mailing Address - Country:US
Mailing Address - Phone:573-756-7880
Mailing Address - Fax:573-756-2669
Practice Address - Street 1:1031 E KARSCH BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3404
Practice Address - Country:US
Practice Address - Phone:573-756-7880
Practice Address - Fax:573-756-2669
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208566216Medicaid
MO590121307Medicaid
110175390OtherRAILROAD MEDICARE
MO505183608Medicaid
MO595444209Medicaid
MO263902Medicare ID - Type UnspecifiedFREDERICKTOWN
MOG34221Medicare UPIN
MO595444209Medicaid
MO208566216Medicaid
000012958Medicare PIN